Bottom Line:
A 64-year-old female with pulsating enophthalmos of the right eye was found to have a right orbital mass with bony defects of the orbit.Valsalva maneuver failed to induce proptosis.Proptosis induced by general anesthesia and positive pressure ventilation suggests an underlying distensible venous anomaly.

Affiliation: Department of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, Australia. eye@health.sa.gov.au

ABSTRACTWe report a case of pulsating enophthalmos secondary to orbital varix associated with orbital bony defects. A 64-year-old female with pulsating enophthalmos of the right eye was found to have a right orbital mass with bony defects of the orbit. Valsalva maneuver failed to induce proptosis. The diagnosis of orbital varix was confirmed by exploratory orbitotomy. During general anesthesia for orbitotomy, proptosis of the right eye was noted. Ophthalmologists should be aware of the association between orbital varices and cranial bony defects and encephaloceles. Proptosis induced by general anesthesia and positive pressure ventilation suggests an underlying distensible venous anomaly.

Figure 0001: Clinical photograph demonstrating enophthalmos of the left eye

Mentions:
On examination, her visual acuity was 20/100 right eye and 20/60 left eye. Her right eye was enophthalmic (Hertel's exophthalmometer readings: 13mm right eye, 17mm right eye with 110mm base) [Fig. 1a]. Pulsations of the right eye, coincident with the arterial pulse, were obvious when viewed from the side. Ocular examination revealed filtering blebs in both eyes and significant glaucomatous optic atrophy of both optic discs. Positional change and Valsalva maneuver did not induce proptosis.

Figure 0001: Clinical photograph demonstrating enophthalmos of the left eye

Mentions:
On examination, her visual acuity was 20/100 right eye and 20/60 left eye. Her right eye was enophthalmic (Hertel's exophthalmometer readings: 13mm right eye, 17mm right eye with 110mm base) [Fig. 1a]. Pulsations of the right eye, coincident with the arterial pulse, were obvious when viewed from the side. Ocular examination revealed filtering blebs in both eyes and significant glaucomatous optic atrophy of both optic discs. Positional change and Valsalva maneuver did not induce proptosis.

Bottom Line:
A 64-year-old female with pulsating enophthalmos of the right eye was found to have a right orbital mass with bony defects of the orbit.Valsalva maneuver failed to induce proptosis.Proptosis induced by general anesthesia and positive pressure ventilation suggests an underlying distensible venous anomaly.

Affiliation:
Department of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, Australia. eye@health.sa.gov.au

ABSTRACTWe report a case of pulsating enophthalmos secondary to orbital varix associated with orbital bony defects. A 64-year-old female with pulsating enophthalmos of the right eye was found to have a right orbital mass with bony defects of the orbit. Valsalva maneuver failed to induce proptosis. The diagnosis of orbital varix was confirmed by exploratory orbitotomy. During general anesthesia for orbitotomy, proptosis of the right eye was noted. Ophthalmologists should be aware of the association between orbital varices and cranial bony defects and encephaloceles. Proptosis induced by general anesthesia and positive pressure ventilation suggests an underlying distensible venous anomaly.